Adapting the ASSIST model of informal peer-led intervention delivery to the Talk to FRANK drug prevention programme in UK secondary schools (ASSIST + FRANK): intervention development, refinement and a pilot cluster randomised controlled trial

White, James; Hawkins, Jemma; Madden, Kim; Grant, Aimee; Er, Vanessa; Angel, Lianna; Pickles, Timothy; Kelson, Mark; Fletcher, Adam; Murphy, Simon; Midgley, Luke; Eccles, Gemma; Cox, Gemma; Hollingworth, William; Campbell, Rona; Hickman, Matthew; Bonell, Chris; Moore, Laurence

doi:10.3310/phr05070

Cited by 13 publications

(11 citation statements)

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“…This study adds to other studies 28,51 that support the design of health behaviour interventions for young people to target their core social networks and the potential positive power of peer influence. As the ASSIST approach to peer-diffusion and our application of it to target PA differs from other peer-led PA interventions, this presents an interesting avenue for future interventions involving peers.…”

Section: Implications For Research and Policymentioning

confidence: 75%

A peer-led physical activity intervention in schools for adolescent girls: a feasibility RCT

et al. 2019

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Background Girls are less active than boys and few adolescent girls meet physical activity (PA) guidelines. Peers are an important influence on the views and behaviours of adolescent girls, yet many PA interventions involving peers use formal approaches that may not harness the power of peer groups. More informal peer-led PA interventions, which work within proximal peer groups, may hold promise for increasing girls’ PA. Objectives To examine the feasibility, evidence of promise and cost of the Peer-Led physical Activity iNtervention for Adolescent girls (PLAN-A), a peer-led PA intervention. Design Phase 1 comprised formative work and a pilot study conducted in one secondary school. Phase 2 was a feasibility study comprising a pilot randomised controlled trial in six secondary schools, including process and economic evaluations. Setting Six secondary schools in South Gloucestershire and Wiltshire, recruited from schools above the median local Pupil Premium (i.e. more deprived). Participants Year 8 girls (aged 12–13 years). Intervention Year 8 girls nominated other girls in their year who are likely to be influential (e.g. who they look up to, are good listeners); the 18% most nominated were invited to be peer supporters (PSs). PSs attended 2 consecutive days of training (plus a top-up day 5 weeks later) outside the school site, led by pairs of PS trainers, to increase their knowledge about PA and their capabilities and confidence to promote PA in their friendship group. Main outcome measures Measures focused on establishing evidence for feasibility and promise: recruitment and retention of Year 8 girls and PSs, data provision rates [accelerometer and questionnaire collected pre randomisation/beginning of Year 8 (T0), end of Year 8 (T1) and beginning of Year 9 (T2)], intervention acceptability, PS training attendance, intervention cost, and the between-arm difference in weekday minutes of moderate to vigorous PA (MVPA). A process evaluation was conducted. Results Six schools were recruited: four PLAN-A (n = 269) and two control (n = 158). In total, 94.7% of Year 8 girls participated. A total of 55 (17–24% of Year 8 girls) PSs were trained (attendance rate 91–100%). Five girls were trained as PS trainers. Questionnaire data provision exceeded 92% at all time points. Accelerometer return rates were > 85% and wear-time criteria were met by 83%, 71% and 62% of participants at T0, T1 and T2, respectively. Mean weekday MVPA did not differ between intervention arms at T1 (1.1 minutes, 95% CI –4.3 to 6.5 minutes) but did at T2 (6.1 minutes, 95% CI 1.4 to 10.8 minutes), favouring PLAN-A. The mean cost of intervention delivery was £2685 per school or £37 per Year 8 girl. Process evaluation identified good fidelity, engagement and enjoyment of the PS training and peer-support strategies. PSs needed more guidance on how to start conversations. Limitations Accelerometer data provision was lowest at T2, suggesting a need for strategies to increase compliance. Conclusions Informal peer-led intervention approaches, such as PLAN-A, hold promise as a means of promoting PA to adolescent girls. Future work A definitive randomised controlled trial of PLAN-A is warranted. Trial registration Current Controlled Trials ISRCTN12543546. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 16. See the NIHR Journals Library website for further project information. The work was undertaken with the support of the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UK Clinical Research Collaboration (UKCRC) Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UKCRC, is gratefully acknowledged. This study was designed and delivered in collaboration with the Bristol Randomised Trials Collaboration (BRTC), a UK CRC-registered clinical trials unit in receipt of NIHR clinical trials unit support funding. The intervention costs were jointly funded by South Gloucestershire Council and Wiltshire Council.

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Section: Implications For Research and Policymentioning

confidence: 75%

A peer-led physical activity intervention in schools for adolescent girls: a feasibility RCT

et al. 2019

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“…Smoking In Schools Trial), is based on the diffusion of innovations theory which utilizes influential pupils to cascade anti-smoking information and has been shown to cost-effectively lead to a reduction in adolescent smoking prevalence 108,109 . The ASSIST framework has also been adopted in other areas of adolescent health behaviour research, including PA 110 , healthy eating for obesity prevention 111 , drug use prevention 112 and sexual health 113 . This review has highlighted incorporation of social network processes within behavior change interventions may increase the effectiveness of such efforts.…”

Section: For Example Assist (A Stopmentioning

confidence: 99%

Peer social network processes and adolescent health behaviors: A systematic review

Montgomery¹,

Donnelly²,

Bhatnagar

et al. 2020

Preventive Medicine

163

109

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Research has highlighted the importance of peers for determining health behaviors in adolescents, yet these behaviors have typically been investigated in isolation. We need to understand common network processes operating across health behaviors collectively, in order to discern how social network processes impact health behaviors. Thus, this systematic review of studies investigated adolescent peer social networks and health behaviors. A search of six databases (CINAHL, Education Resources Information Centre, Embase, International Bibliography of the Social Sciences, Medline and PsycINFO) identified 55 eligible studies. The mean age of the participants was 15.1 years (range 13-18; 51.1% female). Study samples ranged from 143 to 20,745 participants. Studies investigated drinking (31%), smoking (22%), both drinking and smoking (13%) substance use (18%), physical activity (9%) and diet or weight management (7%). Study design was largely longitudinal (n=41, 73%) and cross-sectional (n=14, 25%). All studies were set in school and all but one study focused on school-based friendship networks. The Newcastle-Ottawa scale was used to assess risk of bias: studies were assessed as good (51%), fair (16%) or poor (33%). The synthesis of results revolved around two network behavior patterns: 1) health behavior similarity within a social network, driven by homophilic social selection and/or social influence, and 2) popularity: health behavior engagement in relation to changes in social status; or network popularity predicting health behaviors. Adolescents in denser networks had statistically significant lower levels of harmful behavior (n=2/2, 100%). Findings suggest that social network processes are important factors in adolescent health behaviors.

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“…Response rates were slightly lower than other recent school-based studies. 128,132 As parental opt-out (n = 6) and student non-consent (n = 3) were low, the response rate primarily reflected the number of students who attended school on survey days, and made it to the class in which the questionnaire was administered. There was a suggestion from teachers that the class lists (on which the denominator was based) were not always up to date and included students who did not regularly attend school.…”

Section: Objectivementioning

confidence: 99%

“…The target of 60% was based on the experience of ASSIST and extensions of ASSIST 67,128 [in which role uptake was high (> 90%)], but may have been set too high for the STASH study given the topic and age group of the students. Among younger students in ASSIST, the prospect of a 2-day training out of school provided a strong motivation, whereas in the STASH study this element received a mixed response, because of academic pressures.…”

Section: Objectivementioning

confidence: 99%

A peer-led intervention to promote sexual health in secondary schools: the STASH feasibility study

et al. 2020

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Background Young people report higher levels of unsafe sex and have higher rates of sexually transmitted infections than any other age group. Schools are well placed to facilitate early intervention, but more effective approaches are required. Peer-led approaches can augment school-based education, but often fail to capitalise on mechanisms of social influence. The potential of using social media in sexual health has not been tested in school settings. Objectives Finalise the design of the Sexually Transmitted infections And Sexual Health (STASH) intervention; assess the recruitment and retention of peer supporters, and acceptability to participants and stakeholders; assess the fidelity and reach, in addition to the barriers to and facilitators of, implementation; refine programme theory; understand the potential of social media; determine design parameters for a future randomised controlled trial, including economic evaluation; and establish whether or not progression criteria were met. Design This was a feasibility study comprising intervention development and refinement of the STASH pilot and non-randomised feasibility trial in six schools. Control data were provided by students in the year above the intervention group. Setting Secondary schools in Scotland. Participants Students aged 14–16 years, teachers and intervention delivery partners. Interventions The STASH intervention was adapted from A Stop Smoking In Schools Trial (ASSIST) (an effective peer-led smoking intervention). Based on diffusion of innovation theory, the STASH study involves peer nomination to identify the most influential students, with the aim of recruiting and training 15% of the year group as peer supporters. The peer supporters deliver sexual health messages to friends in their year group via conversations and use of Facebook (www.facebook.com; Facebook, Inc., Menlo Park, CA, USA) to share varied content from a curated set of web-based resources. Peer supporters are given support themselves via follow-up sessions and via trainer membership of Facebook groups. Main outcome measures The primary outcome was whether or not progression criteria were met in relation to intervention acceptability and feasibility. The study also piloted indicative primary outcomes for a full-scale evaluation. Data sources Peer supporter questionnaire; observations of activities; interviews with trainers, teachers, peer supporters and students; monitoring log of peer supporter activities (including on Facebook and meeting attendance); questionnaire to control year group (baseline characteristics, social networks, mediators and sexual health outcomes); baseline and follow-up questionnaire (approximately 6 months later) for intervention year group. Results A total of 104 students were trained as peer supporters (just over half of those nominated for the role by their peers). Role retention was very high (97%). Of 611 students completing the follow-up questionnaire, 58% reported exposure to STASH study activities. Intervention acceptability was high among students and stakeholders. Activities were delivered with good fidelity. The peer supporters were active, representative of their year group and well connected within their social network. Carefully managed social media use by peer supporters augmented conversations. A primary outcome of ‘always safer sex’ was identified, measured as no sex or always condom use for vaginal or anal sex in the last 6 months. The intervention cost £42 per student. Six progression criteria were met. A seventh criterion (regarding uptake of role by peer supporters) was not. Limitations Small feasibility study that cannot comment on effectiveness. Conclusions The STASH intervention is feasible and acceptable within the context of Scottish secondary schools. The results support continuation to a full-scale evaluation. Future work Small-scale improvements to the intervention, refinement to programme theory and funding sought for full-scale evaluation. Trial registration Current Controlled Trials ISRCTN97369178. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 15. See the NIHR Journals Library website for further project information.

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Adapting the ASSIST model of informal peer-led intervention delivery to the Talk to FRANK drug prevention programme in UK secondary schools (ASSIST + FRANK): intervention development, refinement and a pilot cluster randomised controlled trial

Cited by 13 publications

References 37 publications

A peer-led physical activity intervention in schools for adolescent girls: a feasibility RCT

A peer-led physical activity intervention in schools for adolescent girls: a feasibility RCT

Peer social network processes and adolescent health behaviors: A systematic review

A peer-led intervention to promote sexual health in secondary schools: the STASH feasibility study

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